TOPIC:

Hello Everyone ! I was recently diagnosed with GT3 (Age - 48, VL 365,495 Fscan 18.2 Kpa) . Got it in the nineties. On sofosbuvir+daclatasvir right now. No outward symptoms at all. No other conditions except hypertension having telmisartan 40 everyday. I have a question regarding another drug that I occasionally take i.e. sildenafil citrate (viagra) . Does this drug have any contraindications ? Could someone please reply.

Hello Paul, and welcome to the forum . The University of Liverpool in the UK has a dedicated page for checking interactions between the new Hepatitis C medications (DAAs) and other common medications, and when I checked the 'Sofosbuvir + Daclatasvir' combo and 'Sildenafil', the result was 'No Interaction Expected'. You can take a look here www.hep-druginteractions.org/checker

Hi Paul2018,

Welcome to the forum!

There are no interactions between Sofosbuvir and Daclatasvir and Sildenafil. Here's the report from the Liverpool Hep C Drug Interactions Site.

Thanks Dr James, Mar. As I have mentioned my fscan score is 18.2 kpa which is cirrhosis. But I do not have any noticeable symptoms at all. Is it normal not to have any symptoms even with a fscan score of 18.2?

Hi Paul,

Yes it is possible to be cirrhotic with few symptoms.

With GT3 and cirrhosis you must have ribavirin with the Sof/Dac. You should also have 24 weeks treatment.

For GT3 cirrhotics Sof/Vel for 12+ weeks (and preferably with riba) is the best 1st line option.

Hello everyone, after 4 weeks of sof/dac regime my VL is undetected. The doc never prescribed riba. He has said that he may discontinue meds after 8 weeks. I am worried. Is there a possibility of a relapse in future if the recommended 12 weeks is not adhered to?

As I go to a government facility where the meds are given free, I do not have a say in the treatment.

Hi Paul

Thats great about your being UND. @week4, that is certainly what you want to see,however I would say yes it is worrisome for SVR to stop this regime at 8 weeks.

As Dr. freeman pointed out earlier the optimum regime for GT 3 W/ cirrhosis is SOF/VEL for 12 weeks (preferably with Riba added for some insurance.)

However the guidelines do say, and as Dr. Freeman also mentioned if doing SOF/DAC then 24 wks . is recommended also with RIBA.

I would imagine the DR. will chime in and possibly you can chat with him about adding whatever regime he suggests through him to supplement being only given 8 weeks treatment.

If you are only at wk. 4 currently ,hopfully there should still be time to work something out with Dr. Freeman if in fact they will not extend this regime you are on.

Good luck

S

Hi Paul,

You have GT3 and cirrhosis (fibroscan > 12.5kPa)

There are no guidelines anywhere in the world that say 8 weeks of Sof+Dac is appropriate for ANYBODY.

The 8 weeks guideline for Harvoni for treatment naive, GT1, Viral load < 6 million, LOW FIBROSIS patients are well known to produce inferior SVR12 to 12 weeks and do not apply to you anyway.

You need 24 weeks treatment and would have a high probability of relapse if you do only 8 weeks treatment - nobody knows how high because nobody gives that short a treatment.

You should be having ribavirin.

1. What country are you in?
2. How much longer do you have before you finish the 8 weeks?
3. When you do find see your doctor about more treatment?

Here are the EASL guidelines for treatment of cirrhotic patients

I am from India.
My 8 weeks come to an end on 4th Jan '19.
My next doc visit is scheduled on 2nd Jan '19.

Hi Paul, if you're in India, then you should have access to relatively cheap generic HCV medications, and you can ask you doctor where to source 100% authentic high quality generic medications there. I would urge you to follow Dr James's recommendation of completing 24 weeks of Sof/Dac and Ribavirin instead of the just 8 weeks of Sof/Dac that you may be treated with as that will almost certainly lead to relapse.

It has been a little over nine months since the time I underwent a 3 months treatment at a local Community Health Centre. I was on a Sof + Dac regimen for 12 weeks. The doctor advised HCV RNA test a week ago. Virus was not detected. He has not prescribed any other tests and asked me to come back after six months.

Apart from a LFT what are the tests that are normally done after treatment?

Hello Paul2018,

Congrats on the cure result.

In terms of other tests, it depends on how sick a patient is and what has been done previously.

So, say I treat a patient who is not cirrhotic and relatively well and 4 weeks into treatment their LFTs are normal and PCR negative. I would not do any more tests until SVR12 and then just do a PCR and LFTs.

At the other end of the spectrum a patient with cirrhosis who was taking ribavirin would get a CBC and CMP (FBC, UEC, LFT) every 2 weeks during treatment and lots of follow up testing including AFP and ultrasound to check for HCC.

Other tests just depend on the patient and their problems.